Effect of Advanced Access Scheduling on Processes and Intermediate Outcomes of Diabetes Care and Utilization
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The impact of open access (OA) scheduling on chronic disease care and outcomes has not been studied.
To assess the effect of OA implementation at 1 year on: (1) diabetes care processes (testing for A1c, LDL, and urine microalbumin), (2) intermediate outcomes of diabetes care (SBP, A1c, and LDL level), and (3) health-care utilization (ED visits, hospitalization, and outpatient visits).
We used a retrospective cohort study design to compare process and outcomes for 4,060 continuously enrolled adult patients with diabetes from six OA clinics and six control clinics. Using a generalized linear model framework, data were modeled with linear regression for continuous, logistic regression for dichotomous, and Poisson regression for utilization outcomes.
Patients in the OA clinics were older, with a higher percentage being African American (51% vs 34%) and on insulin. In multivariate analyses, for A1c testing, the odds ratio for African-American patients in OA clinics was 0.47 (CI: 0.29-0.77), compared to non-African Americans [OR 0.27 (CI: 0.21-0.36)]. For urine microablumin, the odds ratio for non-African Americans in OA clinics was 0.37 (CI: 0.17-0.81). At 1 year, in adjusted analyses, patients in OA clinics had significantly higher SBP (mean 6.4 mmHg, 95% CI 5.4 – 7.5). There were no differences by clinic type in any of the three health-care utilization outcomes.
OA scheduling was associated with worse processes of care and SBP at 1 year. OA clinic scheduling should be examined more critically in larger systems of care, multiple health-care settings, and/or in a randomized controlled trial.
- Effect of Advanced Access Scheduling on Processes and Intermediate Outcomes of Diabetes Care and Utilization
Journal of General Internal Medicine
Volume 24, Issue 3 , pp 327-333
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- open access
- process of care
- Industry Sectors
- Author Affiliations
- 1. Roudebush VAMC, Indianapolis, IN, USA
- 2. Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- 3. Regenstrief Institute for Healthcare, Inc, Indianapolis, IN, USA
- 8. IF-122, 250 University Blvd, Indianapolis, IN, 46202, USA
- 4. Division of Biostatistics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- 5. Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- 6. Department of Family Medicine, Indianapolis, IN, USA
- 7. Division of Endocrinology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA